Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience

David M Clark, David M Clark

Abstract

The Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to greatly increase the availability of NICE recommended psychological treatment for depression and anxiety disorders within the National Health Service in England. This article describes the background to the programme, the arguments on which it is based, the therapist training scheme, the clinical service model, and a summary of progress to date. At mid-point in a national roll-out of the programme progress is generally in line with expectation, and a large number of people who would not otherwise have had the opportunity to receive evidence-based psychological treatment have accessed, and benefited from, the new IAPT services. Planned future developments and challenges for the programme are briefly described.

Figures

Figure 1
Figure 1
Improvement in PHQ-9 and GAD-7 scores between initial assessment (pre-) and last available session (post-) in people who either completed both the pre- and post-treatment CORE-OM or who failed to complete the CORE-OM at post. Data from the Newham Demonstration site. Figure derived from Clark et al. (2009).

References

    1. Barkham M., Margison F., Leach C., Lucock M., Mellor-Clark J., Evans C, McGrath G. Service profiling and outcomes benchmarking using the CORE-OM: Towards practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology. 2001;69:184–196.
    1. Barlow D.H., Craske M.G. Mastery of your Anxiety and Panic: Therapist Guide for Anxiety, Panic, and Agoraphobia. 4th ed. Oxford: Oxford University Press; 2007.
    1. Blackburn I.-M., James I.A., Milne D.L., Baker C, Standart S., Garland A., Reichelt F.K. The revised cognitive therapy scale (CTS-R): Psychometric properties. Behavioural and Cognitive Psychotherapy. 2001;29:431–446.
    1. Clark D.M., Ehlers A. Posttraumatic stress disorder: From theory to therapy. In: Leahy R.L., editor. Contemporary Cognitive Therapy. New York: Guilford; 2004. pp. 141–160.
    1. Clark D.M., Layard R., Smithies R., Richards D.A., Suckling R., Wright B. Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy. 2009;47:910–920.
    1. Clark D.M., Salkovskis P.M. Panic disorder. In: Hawton K., Salkovskis P.M., Kirk J., Clark D.M., editors. Cognitive Behaviour Therapy: A Practical Guide. 2nd ed. Oxford: Oxford University Press; (in press)
    1. Department of Health. IAPT Implementation Plan: National Guidelines for Regional Delivery. 2008 Available at .
    1. Department of Health. The Operating Framework for the NHS in England 2011/12. 2010 Available at .
    1. Department of Health. No Health Without Mental Health. 2011a Available at .
    1. Department of Health. Talking Therapies: A FourYear Plan. 2011b Available at .
    1. Department of Health. IAPT Data Handbook version 2. 2011c Available at .
    1. Department of Health. Commissioning Talking Therapies for 2011/12. 2011d Available at .
    1. Ehlers A., Clark D.M. A cognitive model of post traumatic stress disorder. Behaviour Research and Therapy. 2000;38:319–345.
    1. Foa E.B., Rothbaum B.A. Treating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD. New York: Guilford; 1998.
    1. Glover G., Webb M., Evison F. Improving Access to Psychological Therapies: A Review of Progress Made by Sites in the First Roll-Out Year. Stockton on Tees: North East Public Health Observatory; 2010. Available at .
    1. Gillespie K., Duffy M., Hackmann A., Clark D.M. Community based cognitive therapy in the treatment of post-traumatic stress disorder following the Omagh bomb. Behaviour Research and Therapy. 2002;40:345–357.
    1. Gyani A., Shafran R., Layard R., Clark D.M. Enhancing Recovery Rates in IAPT Services: Lessons from Analysis of the Year One Data. 2011 Available at .
    1. Kroenke K., Spitzer R.L., Williams J.B. The PHQ-9: Validity of a brief depression severity measure. Journal of General and Internal Medicine. 2001;16:606–613.
    1. Layard R., Bell S., Clark D.M., Knapp M., Meacher M., Priebe S., Wright B. The Depression Report: A New Deal for Depression and Anxiety Disorders. London: London School of Economics; 2006. Centre for Economic Performance Report. Available at: .
    1. Layard R., Clark D.M., Knapp M., Mayraz G. Cost-benefit analysis of psychological therapy. National Institute Economic Review. 2007;202:90–98.
    1. McManus S., Meltzer H., Brugha T., Bebbington P., Jenkins R. Adult Psychiatric Morbidity in England 2007: Results of a Household Survey. Leeds: Health and Social Care Information Centre; 2007.
    1. Mind. We Need to Talk. London: MIND; 2010.
    1. NICE. Anxiety: Management of Anxiety (Panic Disorder, With and Without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care. London: National Institute for Health and Clinical Excellence; 2004a. Clinical Guideline 22. Available at .
    1. NICE. Depression:Management of Depression in Primary and Secondary Care. London: National Institute for Health and Clinical Excellence; 2004b. Clinical Guideline 23. Available at .
    1. NICE. Obsessive-Compulsive Disorder:Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. London: National Institute for Health and Clinical Excellence; 2005a. Clinical Guideline 31. Available at .
    1. NICE. Post-Traumatic Stress Disorder (PTSD): The Management of PTSD in Adults and Children in Primary and Secondary Care. London: National Institute for Health and Clinical Excellence; 2005b. Clinical Guideline 26. Available at .
    1. NICE. Computerized Cognitive Behaviour Therapy for Depression and Anxiety. London: National Institute for Health and Clinical Excellence; 2006. Technology Appraisal 97. Available at .
    1. NICE. Depression: Treatment and Management of Depression in Adults. London: National Institute for Health and Clinical Excellence; 2009a. Clinical Guideline 90. Available at .
    1. NICE. Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. London: National Institute for Health and Clinical Excellence; 2009b. Clinical Guideline 91. Available at .
    1. NICE. Common Mental Health Disorders: Identification and Pathways to Care. London, UK: National Institute for Health and Clinical Excellence; 2011. Clinical Guideline 123. Available at .
    1. Resick P.A., Monson CM., Chard K.M. Cognitive Processing Therapy: VeteranlMilitary Version. Washington, DC: Department of Veterans' Affairs; 2007.
    1. Richards D.A., Suckling R. Improving access to psychological therapies: Phase IV, prospective cohort study. British Journal of Clinical Psychology. 2009;48:377–396.
    1. Roth A.D., Pilling S. Using an evidence-based methodology to identify the competencies required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy. 2008;36:129–147.
    1. Spitzer R.L., Kroenke R., Williams J.B., Lowe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine. 2006;166:1092–1097.
    1. Weiss D.S., Marmar C.R. The Impact of Event Scale revised. In: Wilson J.P., Keane T.M., editors. Assessing Psychological Trauma and PTSD. New York: Guilford; 1997. pp. 399–411.

Source: PubMed

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